Healthcare Provider Details

I. General information

NPI: 1063885036
Provider Name (Legal Business Name): SWEET SMILES DENTAL HYGIENE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 STATE ST STE 11
ELLSWORTH ME
04605-1850
US

IV. Provider business mailing address

PO BOX 1303
ELLSWORTH ME
04605-1303
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-8263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberIPH46
License Number StateME

VIII. Authorized Official

Name: MRS. STEPHANIE RENEE SWETT
Title or Position: OWNER
Credential: IPDH
Phone: 207-479-4110